RESUMEN
SOURCE CITATION: Heming N, Renault A, Kuperminc E, et al; APROCCHSS investigators and CRICS-TRIGGERSEP network. Hydrocortisone plus fludrocortisone for community acquired pneumonia-related septic shock: a subgroup analysis of the APROCCHSS phase 3 randomised trial. Lancet Respir Med. 2024;12:366-374. 38310918.
Asunto(s)
Infecciones Comunitarias Adquiridas , Quimioterapia Combinada , Fludrocortisona , Hidrocortisona , Choque Séptico , Choque Séptico/tratamiento farmacológico , Choque Séptico/mortalidad , Humanos , Hidrocortisona/uso terapéutico , Hidrocortisona/administración & dosificación , Fludrocortisona/uso terapéutico , Infecciones Comunitarias Adquiridas/tratamiento farmacológico , Antiinflamatorios/uso terapéutico , Antiinflamatorios/administración & dosificación , Neumonía/tratamiento farmacológico , Neumonía/mortalidad , Masculino , FemeninoRESUMEN
SOURCE CITATION: Kaye KS, Belley A, Barth P, et al. Effect of cefepime/enmetazobactam vs piperacillin/tazobactam on clinical cure and microbiological eradication in patients with complicated urinary tract infection or acute pyelonephritis: a randomized clinical trial. JAMA. 2022;328:1304-14. 36194218.
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Pielonefritis , Infecciones Urinarias , Humanos , Cefepima/uso terapéutico , Antibacterianos/uso terapéutico , Infecciones Urinarias/tratamiento farmacológico , Combinación Piperacilina y Tazobactam/uso terapéutico , Pielonefritis/tratamiento farmacológicoRESUMEN
SOURCE CITATION: Tsang NN, So HC, Ng KY, et al. Diagnostic performance of different sampling approaches for SARS-CoV-2 RT-PCR testing: a systematic review and meta-analysis. Lancet Infect Dis. 2021. [Epub ahead of print.] 33857405.
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COVID-19 , Faringe , Humanos , Nasofaringe , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , SARS-CoV-2RESUMEN
SOURCE CITATION: Greenhawt M, Abrams EM, Shaker M, et al. The risk of allergic reaction to SARS-CoV-2 vaccines and recommended evaluation and management: a systematic review, meta-analysis, GRADE assessment, and international consensus approach. J Allergy Clin Immunol Pract. 2021;9:3546-67. 34153517.
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COVID-19 , Hipersensibilidad , Vacunas contra la COVID-19 , Consenso , Humanos , Hipersensibilidad/diagnóstico , Hipersensibilidad/prevención & control , SARS-CoV-2RESUMEN
OBJECTIVES: To determine the clinical characteristics and outcomes of culture-negative septic shock in comparison with culture-positive septic shock. DESIGN: Retrospective nested cohort study. SETTING: ICUs of 28 academic and community hospitals in three countries between 1997 and 2010. SUBJECTS: Patients with culture-negative septic shock and culture-positive septic shock derived from a trinational (n = 8,670) database of patients with septic shock. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Patients with culture-negative septic shock (n = 2,651; 30.6%) and culture-positive septic shock (n = 6,019; 69.4%) were identified. Culture-negative septic shock compared with culture-positive septic shock patients experienced similar ICU survival (58.3% vs 59.5%; p = 0.276) and overall hospital survival (47.3% vs 47.1%; p = 0.976). Severity of illness was similar between culture-negative septic shock and culture-positive septic shock groups ([mean and SD Acute Physiology and Chronic Health Evaluation II, 25.7 ± 8.3 vs 25.7 ± 8.1]; p = 0.723) as were serum lactate levels (3.0 [interquartile range, 1.7-6.1] vs 3.2 mmol/L [interquartile range, 1.8-5.9 mmol/L]; p = 0.366). As delays in the administration of appropriate antimicrobial therapy after the onset of hypotension increased, patients in both groups experienced congruent increases in overall hospital mortality: culture-negative septic shock (odds ratio, 1.56; 95% CI [1.47-1.66]; p < 0.0001) and culture-positive septic shock (odds ratio, 1.65; 95% CI [1.59-1.71]; p < 0.0001). CONCLUSIONS: Patients with culture-negative septic shock behave similarly to those with culture-positive septic shock in nearly all respects; early appropriate antimicrobial therapy appears to improve mortality. Early recognition and eradication of infection is the most obvious effective strategy to improve hospital survival.
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Mortalidad Hospitalaria/tendencias , Unidades de Cuidados Intensivos/estadística & datos numéricos , Choque Séptico/mortalidad , Tiempo de Tratamiento/estadística & datos numéricos , APACHE , Anciano , Antibacterianos/administración & dosificación , Cultivo de Sangre , Temperatura Corporal , Comorbilidad , Femenino , Frecuencia Cardíaca , Humanos , Hipotensión/etiología , Hipotensión/terapia , Ácido Láctico/sangre , Masculino , Persona de Mediana Edad , Respiración Artificial , Estudios Retrospectivos , Choque Séptico/complicaciones , Factores de TiempoAsunto(s)
COVID-19 , COVID-19/epidemiología , COVID-19/prevención & control , Niño , Humanos , Estados Unidos/epidemiología , VacunaciónRESUMEN
Pulsed-field gel electrophoresis (PFGE) is a common method used to type methicillin-resistant Staphylococcus aureus (MRSA) in nosocomial investigations and epidemiological studies but is time-consuming and methodologically challenging. We compared typing results obtained using a commercial repetitive-element PCR (rep-PCR) system with PFGE in a sample of 86 unique MRSA isolates recovered from subjects in an academic referral hospital and two nursing homes in the same geographic region. Both methods reliably assigned isolates to the same Centers for Disease Control and Prevention (CDC) pulsotype. PFGE was significantly more discriminatory (Simpson's index of diversity, 0.92 at the 95% strain similarity threshold) than the commercial rep-PCR system (Simpson's index of diversity, 0.58). The global (adjusted Rand coefficient, 0.10) and directional congruence (adjusted Wallace coefficient(repPCRâPFGE) = 0.06; adjusted Wallace coefficient(PFGE â repPCR) = 0.52) between the two methods was low. MRSA strains recovered from study nursing homes that were clonal when typed by the commercial rep-PCR method were frequently noted to be genetically distinct when typed using PFGE. These data suggest that the commercial rep-PCR has less utility than PFGE in small-scale epidemiological assessments of MRSA in health care settings.
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Técnicas de Tipificación Bacteriana/métodos , Electroforesis en Gel de Campo Pulsado/métodos , Staphylococcus aureus Resistente a Meticilina/clasificación , Staphylococcus aureus Resistente a Meticilina/genética , Tipificación Molecular/métodos , Reacción en Cadena de la Polimerasa/métodos , Adolescente , Adulto , Estudios de Cohortes , Infección Hospitalaria/microbiología , Microbiología Ambiental , Femenino , Genotipo , Instituciones de Salud , Humanos , Estudios Longitudinales , Masculino , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Epidemiología Molecular/métodos , Infecciones Estafilocócicas/microbiología , Adulto JovenRESUMEN
OBJECTIVE: Catheter-related bloodstream infections are associated with significant costs and adverse consequences. Arterial catheters are commonly used in the critical care setting and are among the most heavily manipulated vascular access devices. We sought to evaluate the prevalence of arterial catheter-related bloodstream infection. DATA SOURCES: PubMed, CinAHL, EMBASE, and Web of Science. STUDY SELECTION: Included studies reported prevalence rate of catheter-related bloodstream infection for arterial catheters used for critical illness or postoperative monitoring. For the purposes of this study, catheter-related bloodstream infection was defined as positive blood culture collected from an arterial catheter and from the periphery with the same organism in a patient demonstrating systemic signs of sepsis. DATA EXTRACTION: The study population, site of insertion, antiseptic preparation, catheter days, and prevalence of catheter-related bloodstream infection were abstracted. When data were not available, authors were contacted for further information. DATA SYNTHESIS: Forty-nine studies met criteria including 222 cases of arterial catheter-related bloodstream infection in 30,841 catheters. Pooled incidence was 3.40/1,000 catheters or 0.96/1,000 catheter days. Prevalence was considerably higher in the subgroup of studies that cultured all catheters (1.26/1,000 catheter days) compared with those studies that cultured only when the arterial catheter was suspected as the source for the catheter-related bloodstream infection (0.70/1,000 catheter days). Pooled data also found a significantly increased risk of infection for femoral site of insertion compared with radial artery for arterial catheter placement (relative risk, 1.93; 95% CI, 1.32-2.84; p = 0.001) CONCLUSIONS: Arterial catheters are an underrecognized cause of catheter-related bloodstream infection. Pooled incidence when catheters were systematically cultured and correlated to blood culture results indicated a substantial burden of arterial catheter-related bloodstream infection. Selection of a radial site over a femoral site will help reduce the risk of arterial catheter-related bloodstream infection. Future studies should evaluate technologies applied to preventing central venous catheter-related bloodstream infection to arterial catheters as well.
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Infecciones Relacionadas con Catéteres/prevención & control , Cateterismo Periférico/efectos adversos , Infección Hospitalaria/prevención & control , Guías de Práctica Clínica como Asunto , Infecciones Relacionadas con Catéteres/epidemiología , Infección Hospitalaria/epidemiología , Humanos , Unidades de Cuidados IntensivosRESUMEN
OBJECTIVE: To assess the efficacy of a chlorhexidine-impregnated dressing for prevention of central venous catheter-related colonization and catheter-related bloodstream infection using meta-analysis. DATA SOURCES: Multiple computerized database searches supplemented by manual searches including relevant conference proceedings. STUDY SELECTION: Randomized controlled trials evaluating the efficacy of a chlorhexidine-impregnated dressing compared with conventional dressings for prevention of catheter colonization and catheter-related bloodstream infection. DATA EXTRACTION: Data were extracted on patient and catheter characteristics and outcomes. DATA SYNTHESIS: Nine randomized controlled trials met the inclusion criteria. Use of a chlorhexidine-impregnated dressing resulted in a reduced prevalence of catheter-related bloodstream infection (random effects relative risk, 0.60; 95% CI, 0.41-0.88, p = 0.009). The prevalence of catheter colonization was also markedly reduced in the chlorhexidine-impregnated dressing group (random effects relative risk, 0.52; 95% CI, 0.43-0.64; p < 0.001). There was significant benefit for prevention of catheter colonization and catheter-related bloodstream infection, including arterial catheters used for hemodynamic monitoring. Other than in low birth weight infants, adverse effects were rare and minor. CONCLUSIONS: Our analysis shows that a chlorhexidine-impregnated dressing is beneficial in preventing catheter colonization and, more importantly, catheter-related bloodstream infection and warrants routine use in patients at high risk of catheter-related bloodstream infection and central venous catheter or arterial catheter colonization.
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Antiinfecciosos Locales/administración & dosificación , Vendajes , Infecciones Relacionadas con Catéteres/prevención & control , Clorhexidina/administración & dosificación , Antiinfecciosos Locales/efectos adversos , Clorhexidina/efectos adversos , Contaminación de Equipos , Humanos , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
On January 18, 2024, the US Centers for Disease Control and Prevention issued their most recent guidelines for over-the-counter drugs for coronavirus disease 2019 (COVID-19). Specifically, the organization stated that "Most people with COVID-19 have mild illness and can recover at home. You can treat symptoms with over-the-counter medicines, such as acetaminophen (Tylenol) or ibuprofen (Motrin, Advil), to help you feel better." In this review we consider the contributions of different types of evidence and conclude that healthcare providers should make individual clinical judgments for each of their patients in the selection of over-the-counter drugs to treat symptoms of COVID-19. This judgment should be based on the entire benefit to risk profile of the patient. It is our belief that the individual healthcare provider knows far more about each of his or her patients than anyone, including expert members of guideline committees. Their astute and judicious individual clinical decision-making for each individual patient based on all these considerations has the potential to do far more good than harm.
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Tratamiento Farmacológico de COVID-19 , Medicamentos sin Prescripción , Guías de Práctica Clínica como Asunto , Humanos , Medicamentos sin Prescripción/uso terapéutico , COVID-19 , Estados Unidos , SARS-CoV-2 , Personal de Salud , Índice de Severidad de la EnfermedadRESUMEN
In this original research we present new emerging data in COVID-19 that create urgent challenges for health providers in prevention and treatment. Health providers should be aware that COVID-19 cases, hospitalizations, and deaths have increased markedly in August 2023. Further, recent data demonstrate a new emerging strain resistant to prior natural and vaccine immunity. The most recent emerging data show that only this updated COVID-19 vaccine produces the same immune response as previous vaccines that reduced mortality by over 95â¯% and morbidity by over 99â¯%. This recommendation encompasses all adults and children aged 6 months and older, regardless of whether they have had a prior COVID-19 infection or even if they have never received a prior vaccination. This updated COVID-19 vaccine, approved in September 2023, will be the best means to prevent COVID-19 during this upcoming season of respiratory viruses. In the meanwhile, all members of the US population regardless of previous natural infection, vaccines, or boosters are equally susceptible. At present, health providers should counsel all their patients about masking, social distancing, and avoiding crowds, especially indoors where regions of extreme weather conditions are keeping people indoors in closed quarters. In the treatment of COVID-19 the major clinical challenge to health providers, especially in their Black patients, is to prescribe Paxlovid during the first 5 days after onset of symptoms and a positive test.
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COVID-19 , Vacunas contra la Influenza , Gripe Humana , Lactamas , Leucina , Nitrilos , Prolina , Ritonavir , Niño , Adulto , Humanos , COVID-19/epidemiología , COVID-19/prevención & control , Gripe Humana/prevención & control , Vacunas contra la COVID-19/uso terapéutico , Combinación de MedicamentosRESUMEN
We report the findings of a study examining the relationship between in vitro daptomycin-rifampin synergy and the therapeutic outcome of 12 patients with complex deep methicillin-resistant Staphylococcus aureus (MRSA) infections treated for prolonged periods with this combination. Checkerboard synergy was found in nine cases and was 100% predictive of therapeutic success; absence of synergy was found in three cases, two of which were therapeutic failures (P = 0.045). No relationship was observed between synergy and outcome by time-kill assessment. Checkerboard synergy may predict clinical response to daptomycin plus rifampin for complex invasive MRSA infections requiring prolonged treatment.